INFECTIONS Flashcards
vaginal pH
4-4.5
glycogen - present in healthy mucosal vagina
pH suggestive of menopause
6.0 to 7.5
MCC of vaginal discharge among reproductive aged women
BACTERIAL VAGINOSIS
nonirritating, malodorous vaginal discharge
unpleasant vaginal odor - musty or fishy
thin and gray white frothy
Diagnostic criteria for bacterial vaginosis
AMSEL CRITERIA (3 out of 4)
pH > 4.7
(+) clue cells
homogenous milky white discharge
release of fishy odor when KOH is added
microscopic evaluation of vaginal secretion saline preparation
release of volatile amines (w/ fishy odor) produced by anaerobic metabolism
determination of vaginal pH
vaginal pH of bacterial vaginosis
> 4.7 - d.t. DECREASED acid production of bacteria
Diagnostics of Bacterial Vaginosis
(+) clue cells
homogenous milky white discharge
release of fishy odor when KOH is added
Bacterial Vaginosis causes
Gardnerella vaginalis Ureaplasma urealyticum Mobiluncus specieis Mycopladma hominis Prevotella species
Treatment for Bacterial Vaginosis
Metronidazole 500 mg/tab BID for 7 days
Metronidazole 250 mg/tab BID for 7 days
Clindamycin 300 mg/cap BID for 7 days
Maternal and Fetal Effects of Bacterial Vaginosis
abortion preterm delivery, PROM chorioamnionitis, intraamniotic infection postpartum endometritis post cesarean wound infection
Highly contagious STI that is caused by a unicellular organism that is normally fusiform in shape
TRICHOMONIASIS
Symptoms of Trichomoniasis
dysuria, dyspareunia, vulvar pruritus, vaginal spotting, pain
foul, thin and yellow or green vaginal discharge
“strawberry cervix”
Diagnosis of Trichomoniasis
saline wet mount - motile trichomonads vaginal pH > 4.5 culture - GOLD standard pap smear (liquid based( DNA probe rapid test (antigen detection) NAAT (urine or vaginal swab)
Maternal and Fetal Effects of Trichomonas
preterm labor and birth
PROM
postpartum endometritis
low birth weight infant
Management of Trichomoniasis
POGS Clinical Practice Guidelines
METRONIDAZOLE 2 grams single dose
partners should be treated
withhold Metronidazole until the 1st trimester
treat symptomatic pregnant women regardless of pregnancy
breastfeeding must be WITHHELD up to 12-24 hrs AFTER last dose
Manifestations of Vulvovaginal Candidiasis
vulvar pruritus - MC
thick white curdy discharge
erythema, irritation
external dysuria and dyspareunia
Diagnosis of Vulvovaginal Candidiasis
KOH (10%) or saline wet prep
normal pH (4.0 - 4.5)
Treatment of Vulvovaginal Candidiasis
AZOLE CREAMS Butoconazole Clotrimazole Miconazole Terconazole
RECOMMENDED FOR PREGNANCY
topical azole therapies (cream, suppository, tablet) applied for 7 days
FLUCONAZOLE - CONTRAINDICATED
Causes of Suppurative (Mucopurulent Cervicitis)
Chlamydia trachomatis
Neisseria gonorrhea
Maternal Effects of Chlamydia
preterm labor with PROM postpartum endometritis PID salpingitis Fitz Hugh Curtis syndrome Reiter's syndrome
Fetal Effects of Chlamydia
Neonatal pneumonia
Opthalmia neonatorum
Management of Chlamydia
prenatal screening
AZITHROMYCIN 1 g PO as a single dose - DOC
AMOXICILLIN 500 mg PO TID for 7 da
Alternatives - Erythromycin base or Erythromycin ethylsuccinate
sexual partners during the 60 days preceding the onset should be evaluated and treated
Maternal Complications of Gonorrhea
septic abortion
preterm delivery, PROM
chorioamnionitis
postpartum infection (endometritis, PID)
accessory gland infection (Bartholin and Skene’s gland)
perihepatitis (Fits-Hugh-Curtis syndrome)
meningitis and endocarditis
Perinatal Complications of Gonorrhea
opthalmia neonatorum
pharyngeal and respiratory tract infection
anal canal infection
Management of Gonorrhea
Ceftriaxone 250 mg IM, single dose OR
Cefixime 400 mg/tab, single dose OR
Single dose injectible cephalosporin regimen
PLUS
Azithromycin 1 gram PO as single dose
PLUS
treatment for Chlamydial infection unless it is excluded
ALL NEWBORNS ARE GIVEN OCULAR PROPHYLAXIS
0.5 % erythromycin ointment w/n 1 hr after birth OR
1 % silver nitrate solution OR
1 % tetracycline ointment or solution
Infections whose complications increase during pregnancy
UTI
Bacterial Vaginosis
Surgical wound
Group B Streptococcal
Infections more common in pregnancy and the puerperium
Pyelonephritis
Endomyometritis
Mastitis
Toxic Shock Syndrome (TSS)
Infections specific to pregnancy
Chorioamnionitis
Septic pelvic thrombophlebitis
Episiotomy or Perineal lacerations
Infections that affect the fetus
Neonatal sepsis (GBS, E. coli) HSV VZV Parvovirus B19 CMV Rubella HIV Hepatitis B and C Gonorrhea Chlamydia Syphilis Toxoplasmosis Zika virus
Treatment for UTI/Asymptomatic Bacteriuria
Amoxicillin
Nitrofurantoin
TMP-SMX
Cephalexin
Treatment for Pyelonephritis
IV hydration
IV antibiotics
*Cephalosporins (Cefazolin, Cefotetan, or Ceftriaxone) OR Ampicillin and Gentamicin – until afebrile and asymptomatic for 24-48 hrs
Major risk factors for developing pyelonephritis
Previous pyelonephritis
History of vesicoureteral reflux
ASB
Maternal and Fetal Effects of Bacterial Vaginosis
Abortion PPROM preterm delivery Puerperal infections --- chorioamnionitis and endometritis Postpartum endometritis Post cesarean wound infection
Intrauterine inflammation, infection or both (TRIPLE I)
MC precursor of neonatal sepsis
Chorioamnionitis
Diagnosis for Triple I
2 > 38 C, 30 mins apart with additional clinical factor
- elevated maternal WBC count (> 15 000/mL)
- purulent fluid from cervical os
- fetal tachycardia (> 160 bpm)
- evidence from amniocentesis consistent with microbial invasion
Gold standard for diagnosis of chorioamnionitis
Culture of amniotic fluid obtained via amniocentesis
MCC of congenital viral infection
Cytomegalovirus (CMV) growth restriction microcephaly, intracranial calcifications chorioretinitis mental and motor retardation sensorineural deficits hepatosplenomegaly, jaundice hemolytic anemia thrombocytopenic purpura (blueberry muffin baby)
